Vital Sign Abnormalities on Discharge Do Not Predict 30-Day Readmission

Abstract

Objective: Hospital readmissions are common and expensive. Risk factors for hospital readmission may include vital sign abnormalities (VSA) at the time of discharge. The study aimed to validate VSA at the time of discharge as a useful predictor of hospital readmission within 30 days of discharge. VSA was compared to the validated HOSPITAL score and LACE index readmission risk prediction models.Design: All adult medical patients discharged from internal medicine hospitalist service were studied retrospectively. Variables such as age, gender, diagnoses, vital signs at discharge, 30-day hospital readmission, and components for the HOSPITAL score and LACE index were extracted from the electronic health record for analysis. Settings:A 507-bed university-affiliated tertiary care center. Participants:During the 2-year study period, a cohort of 1,916 discharges for the hospitalist service were evaluated. The final analysis was based on the data from 1,781 hospital discharges that met the inclusion criteria.Results: VSA was found in 13% of the study population. Only one abnormal vital sign was present in a higher proportion readmitted to the hospital within 30 days of discharge. No discharges had three or more unstable vital signs. Receiver operating characteristic (ROC) comparisons of the HOSPITAL score (C statistic of 0.67, P < 0.001), LACE index (C statistic of 0.61, P < 0.001), and VSA (C statistic of 0.52, P = 0.318) indicated that VSA at time of discharge was not a useful predictor of hospital readmission within 30 days of discharge. Conclusion:Our study indicated that VSA at the time of discharge is not a useful predictor of 30-day hospital readmission at a university-affiliated teaching hospital. The more complex and validated HOSPITAL score and LACE index were useful predictors of hospital readmission in this patient population.

HOSPITAL Score, LACE Index and LACE+ Index as predictors of 30-day readmission in patients with heart failure

“…The readmission rate in this study is high (27%) but is comparable with previous results at this centre (12%–27%) 12–15. Local factors that may contribute to this higher than expected rate of readmission are a lack of a multidisciplinary heart failure management clinic and a high proportion of patients with negative social determinants of health, such as poverty, poor healthcare access and rural residence.…”

Heart Failure Drug Class Effects on 30-Day Readmission Rates in Patients with Heart Failure with Preserved Ejection Fraction: A Retrospective Single Center Study

“…HF hospitalization rate for patients with both HFpEF and HFrEF in six months was static and significantly lower in the treatment group compared to the control group [9]. In our study, the readmission rate is quite high at 27%, but is comparable with previous results at this center ranging from 12% to 27% [10][11][12][13]. Local factors that may contribute to this higher than expected rate of readmission can be attributed to a lack of a multidisciplinary heart failure management clinic and a high proportion of patients with negative social determinants of health such as poverty, poor healthcare access, and rural residence.…”

Predictors of 30-day hospital readmission: The direct comparison of number of discharge medications to the HOSPITAL score and LACE index

“…8,10,11 Another simple prediction model for predicting hospital readmission which uses both administrative and primary data is the LACE index. 12 The LACE index uses four variables: length of stay, acuity of the admission, comorbidity of the patient and emergency department use in the duration of 6 months before admission. 12 This model has been internally validated using data collected from 4,812 patients discharged from 11 community hospitals in Ontario, and it was externally validated using administrative data collected randomly from 1,000,000 discharges.…”

“…12 The LACE index uses four variables: length of stay, acuity of the admission, comorbidity of the patient and emergency department use in the duration of 6 months before admission. 12 This model has been internally validated using data collected from 4,812 patients discharged from 11 community hospitals in Ontario, and it was externally validated using administrative data collected randomly from 1,000,000 discharges. 12 The LACE index has been shown to have moderate discrimination in studies conducted in North America with over 26,000 Medicare admissions, 13 110,000 discharges in the Chicago, Illinois area 14 and 600 patients in a community hospital.…”

“…12 This model has been internally validated using data collected from 4,812 patients discharged from 11 community hospitals in Ontario, and it was externally validated using administrative data collected randomly from 1,000,000 discharges. 12 The LACE index has been shown to have moderate discrimination in studies conducted in North America with over 26,000 Medicare admissions, 13 110,000 discharges in the Chicago, Illinois area 14 and 600 patients in a community hospital. 15 Despite this accuracy, these risk identification tools do not identify modifiable risk factors for hospital readmission.…”